HomeMy WebLinkAbout57 WIlfin Road 2026 ApplicationRENTAL REGISTRATION APPLICATION 2026
TOWN OFYARMOUTH HEALTH DEPARTMENT
1 1 48 ROUTE 28, SOUTH YARMOUTH, MA 026649
tr RENEWAL
E] NEW APPIICATION
Public Hcaftli
PLEASE REGISTER YOUR RENTAL PROPERIY NO LATER THAN APRIL 1, 2026
IMPORTANT RENTAL CERTIFICATE NOTICE
IF YOU OO NOI RECEIVE YOUR RENTAT CERTIFICATE WITHIN 30 DAYS OFAPPLYING, CONTACT THE HEALTH DEPARTMENT
IMMEDIATELY UNTIL YOU RECEIVE THE CERTIFICATE, YOUR PROPERTY IS CONSIDERED NOT CERTIFIED FOR RENTAL, WHICH MAY
RESULT IN FINES AND PENALTIES.
APPLICATION PROCESS
SUBMITTING THE APPLICATION DOES NOT AUTOMAIICALLY ISSUE A RENTAL CERTIFICATE. A REVIEW PROCESS FOLLOWS, WHICH
INCLUDES:. VERIFICATION OF ASSESSOR RECORDSO SEPTIC SYSTEM CHECK. NUMBER OF LEGAL BEDROOMS
. VIEW OF PREVIOUS INSPECTIONS
OCCUPANCY LIMITS
DETERMINED BY. SEPTIC SYSTEM CAPACIry. NUMBER OF LEGAL BEDROOMS
WHYTHIS MATTERS: rHESE MEASUBES PROTEoT DNNKTNGWATER AND AQU|FERS, ESPECIALLY AS THE TOWN
IRANS'T'ONS TOA FUTURE SEWER SYSTEM.
SMOKE AND CARBON MONOXIDE DETECTORS
AS PART OF YOUR COMPLIANCE RESPONSIBILITIES, PLEASE ENSURE THE FOLLOWING:
. ALL SMOKE DETECTORS & CARBON MONOXIDE DETECTORS HAVE FRESH BATTERIES. ALL UNITS HAVE BEEN TESTED AND ARE IN PROPERWOBKING CONDITION
. ALL UNITSARE LESS THAN 10 YEARS OLD
OWNER INITIALS
Smoke Detector Location Requirements - Yarmouth. MA - copy avaitabte at Buitding Department
FEES PER UN
SHORT.TERM / WEEKLY RENTALS
RENTALS OF 31 DAYS OR TESS
IN SPEC]]oAS R E O U I R E D Y E A R LY
$180 ANNUALLY
LONG-TERM / YEAR-ROUND RENTALS S8O ANNUALLY
A NON-REFUNDABLE APPLICATION FEE OF S8O PER UNIT/RENTAL IS REQUIRED
AN ADDMONAT FEE OF $1OO PER UN]T/RENTAI IS REQUIRED FOR SHORT.TERM RENTALS PER EUILDING CODE
RENTAL CERTIFICATES EXPIRE ON OECEMBER 31ST OF EACH YEAR
MAIL oR DROP oFF CHECK To THE YARMOUTH HEALI}I DEPAFTMENT: 1146 ROUIE 28, SOUTH vARMOUTH, MA 02664TO REGISTER ONTINE AND PAY VIA CREDITCARD, VISIIIHE TOWN OF YARMOUTH HEALTH DEPARTMENT WEBSITE:
h a;l ryww,yamouth.ma,us1l27 l{eatth
OWNER CERTIFICATION REOUIRED
I CERTIFYTHAT I HAVE COMPLETED THE ABOVE REQUIBEMENTS
DUPLEVMULTI-FAMILY RENTALS. REFUSE DISPOSAL RESPONSIBILITY
OWNER INITIALS
RENTAL INFORMANON
INCOMPLETE FORMS WTHOUT A VALID PHONE # OR EMAITWLL NOT BE PROCESSED
/vRENTAL PROPERry ADDRESS
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? /zr'tYsv c-/,z(L^€/vln-<H?e€, ,/-/A OZO /7PROPERry OWNER MAILING ADDRESS
ALTEBNATIVE PHONE #
Fniptrcaate bSo, S(2, tV?8PROPERTY OWNER PHONE #
REeUIRED 32t.372 .S Zg Z .
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REQUIRED
OWNER'S REPRESENTATIVE/RENTAL AGENT
IF APPLICABLE
REPRESENTATIVE PHONE #
REQUIRED
REPRESENTATIVE EMAIL ADDRESS
REQUIRED
tr LoNG-TERM/yEAR-RouND odnoRt-tenuaryrErrv /u *'z tyRENTAL PERIOD:
TRASH BEI'4OVAL BY
PAID PICK.UP TRASH COMPANY NAME:
edruen trTENANr
RENTAL OF:
Df,6usr trDUpLEx trcoNDo tr APARTMENT trRooM
ACKNOWLEDGMENT STATEMENT
These documents are avaitabte for reference on the otficiat Town of Yarmouth website and may atso be obtained upon request lrom the
yarmouth Heatth Department. Furthermore, I understand that I am required to notity the Heatth Department in writing when I cease
rentingthe property. Fail.ure to do so may resutt in the imposition offines and/or fees.
Hsbitstion
NS:
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APPLICANT SIGNATURE DATE
3, t7 ZL
ln accordance with 105 CmR 410.560, and o(cept as provided in 105 CMR 410.560{C} (torBULK items} , the owner of any residence
containingtwo or mor6 dwallin6 unhs, a rcoming house, homoLess 3helter, or manufactured hoGing community,3hall be
r8ponsiblo for and psyforthofinat cotloction and ultimato disposat qf rotu3e.
I, THE OWNER, CERTIFY THAT MY RENTAL PROPERry WHICH CONTAINS TWO OR MORE DWELLING UNITS, IS IN COMPLIANCE
wlTH MA STATE SANITARY CODE 105 CMR 410.s60 (C) AND 10s CMR410.560 (4)(E).
NUMBER OF UNITS FOR RENT:
Town08
Sanit8ry